What are Out-of-Pocket Maximums?
Your out-of-pocket maximum or limit is the most you will ever have to pay out of your own pocket for annual health care. This limit includes the deductible, copays, and coinsurance you will continue to pay after you reach the deductible. However, your monthly premium is not included in the out-of-pocket maximum.
An average of the 2016 maximums demonstrates that a high percentage of plans have lower out-of-pocket maximums than required by the ACA, which are:
- Bronze: $6,646
- Silver: $6,160
- Gold: $4,762
- Platinum: $2,437
Typically, the out-of-pocket maximum is higher than your deductible amount to account for the collective costs of all types of out-of-pocket expenses such as deductibles, coinsurance, and copayments.
The type of plan you purchase can determine the amount of out-of-pocket maximum vs. deductible costs you will incur. HealthMarkets can help you find the right health plan for your budget and medical needs.
ConsumerReports: http://www.consumerreports.org/cro/news/2013/12/what-s-the-difference-between-a-deductible-and-an-out-of-pocket-limit/index.htm | Kaiser Health News: http://khn.org/news/many-obamacare-plans-set-out-of-pocket-spending-limits-below-the-cap/